Sexual Misconduct: ACOG Committee Opinion Summary, Number 796.

The practice of obstetrics and gynecology includes interaction in times of intense emotion and vulnerability for patients and involves sensitive physical examinations and medically necessary disclosure of private information about symptoms and experiences. The patient-physician relationship is damaged when there is either confusion regarding professional roles and behavior or clear lack of integrity that allows sexual exploitation and harm. Sexual misconduct by physicians is an abuse of professional power and a violation of patient trust. Although sexual misconduct is uncommon in clinical care, even one episode is unacceptable. Routine use of chaperones, in addition to the other best practices outlined in this Committee Opinion, will help assure patients and the public that obstetrician-gynecologists are maximizing efforts to create a safe environment for all patients.

Sexual Misconduct: ACOG Committee Opinion, Number 796.

The practice of obstetrics and gynecology includes interaction in times of intense emotion and vulnerability for patients and involves sensitive physical examinations and medically necessary disclosure of private information about symptoms and experiences. The patient-physician relationship is damaged when there is either confusion regarding professional roles and behavior or clear lack of integrity that allows sexual exploitation and harm. Sexual misconduct by physicians is an abuse of professional power and a violation of patient trust. Although sexual misconduct is uncommon in clinical care, even one episode is unacceptable. Routine use of chaperones, in addition to the other best practices outlined in this Committee Opinion, will help assure patients and the public that obstetrician-gynecologists are maximizing efforts to create a safe environment for all patients.

Psychotherapy in the #MeToo era: Ethical issues.

The #MeToo movement has heightened awareness of sexual assault and harassment, causing victims, perpetrators, observers, and loved ones to reflect on what constitutes sexual coercion and what signifies consent. These new conversations have had powerful effects: Survivors who were once silent have raised their voices; hundreds of men in powerful positions across the United States have been dismissed from their jobs; and societal norms related to sex and gender are being reconsidered. It is no wonder that the "national reckoning" enters the world of psychotherapy. This article explores three vignettes that consider therapeutic facilitation of apologies/reconciliations, psychotherapist values and advocacy, and men and #MeToo using the American Psychological Association Ethics Code as the basis to understand coercion and consent in this new cultural zeitgeist. The ethical, legal, and clinical ramifications inherent in these vignettes are highlighted as a way to assist psychotherapists in beginning to deal with #MeToo as it presents in psychotherapy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Ethical considerations for addressing distorted beliefs in psychotherapy.

With rising rates of misinformation, psychotherapists are likely to encounter clients with distorted beliefs that are scientifically unsound. In situations where these beliefs are harmful (e.g., vaccination refusal, misunderstanding of sexual consent), psychotherapists may face an ethical dilemma regarding how to proceed with psychotherapy. This is especially true if such beliefs are impairing treatment progress or resulting in safety concerns for the client or society. Questions about whether and how the psychotherapist should address these distorted beliefs are therefore likely to arise. In such cases, psychotherapists are tasked with respecting the client's autonomy, while simultaneously being of maximum benefit to the client and to society at large. Not all distorted beliefs warrant therapeutic intervention, but this judgment requires careful consideration. The current article addresses the relevant ethical considerations for navigating and addressing distorted beliefs in psychotherapy. A vignette is offered, and relevant sections of the American Psychological Association's Ethics Code are discussed, both as they pertain to this scenario and as they apply more generally to the practice of psychotherapy. The article concludes with questions for psychotherapists to consider and recommendations for how to proceed when confronted with harmful distorted beliefs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Sex: we can't have it both ways.

I analyse the tension between a plausible liberal view of sex work and the similarly plausible idea that rape and other forms of sexual violence are made morally worse by their sexual nature. I find no conclusive reason to drop the liberal view of sex work, at least as long as the concept of voluntary and informed consent at the core of it is robust enough to account for the realities of prostitution around the world; nor should we abandon the idea that rape is no ordinary immoral act: reducing sexual violence to non-sexual violence would misrepresent the relevant phenomena and perpetuate injustice.

Serious Ethical Violations in Medicine: A Statistical and Ethical Analysis of 280 Cases in the United States From 2008-2016.

Serious ethical violations in medicine, such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries, directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances (97%) of intentional wrongdoing (99%), by males (95%) in nonacademic medical settings (95%), with oversight problems (89%) and a selfish motive such as financial gain or sex (90%). More than half of cases involved a wrongdoer with a suspected personality disorder or substance use disorder (51%). Despite clear patterns, no factors provide readily observable red flags, making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of 10 questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions.

El martillo de las brujas al caso Belén / From Hammer of Witches to Belen's case / Del martell de les bruixes al cas Belén

El presente texto parte de la existencia de una íntima relación entre el modo de definir lo ilícito y el procedimiento que se establece para su persecución. Desde esa perspectiva, analiza las previsiones del Malleus Maleficarum ("Martillo de las Brujas") para la tortura de una mujer acusada de brujería. Luego explora las continuidades entre el Malleus y el proceso penal del caso "Belén", con referencias al uso del lenguaje en la doctrina jurídica argentina en referencia al abuso sexual y otros delitos. Por último, plantea interrogantes en cuanto a los significados subyacentes de la punición del aborto que aun rige en la Argentina

The present article originates in the existence of an intimate relationship between the way in which crime is defined, and the procedure prescribed for its prosecution. From this perspective, it begins with an analysis of the guidelines provided in the Malleus Maleficarum ("Hammer of Witches") for the torture of a woman charged with witchcraft. Then, it explores the connections between the content of the Malleus and the criminal prosecution of "Belen's case", focusing on the use of language in Argentinian doctrine about sexual abuse and other crimes. Finally, it poses questions about the underlying significances meanings in the prosecution of abortion, which still prevails in Argentinian current law

Aquest article parteix de l'existència d'una íntima relació entre la manera de definir l'il·lícit penal i el procediment que s'estableix per a la seva persecució. Des d'aquesta perspectiva, s’hi analitza les previsions del Malleus Maleficarum ("Martell de les Bruixes") per a la tortura d'una dona acusada de bruixeria. A continuació, s’hi estudia la continuïtat entre el Malleus i el procés penal del cas Belén, amb referències a l'ús del llenguatge en la doctrina jurídica argentina sobre l'abús sexual i altres delictes. Finalment, s’hi plantegen diferents interrogants en quant al significat subjacent a la punició de l'avortament que regeix a l'Argentina

Engendering healthy masculinities to prevent sexual violence: Rationale for and design of the Manhood 2.0 trial.

Violence against women and girls is an important global health concern. Numerous health organizations highlight engaging men and boys in preventing violence against women as a potentially impactful public health prevention strategy. Adapted from an international setting for use in the US, "Manhood 2.0" is a "gender transformative" program that involves challenging harmful gender and sexuality norms that foster violence against women while promoting bystander intervention (i.e., giving boys skills to interrupt abusive behaviors they witness among peers) to reduce the perpetration of sexual violence (SV) and adolescent relationship abuse (ARA). Manhood 2.0 is being rigorously evaluated in a community-based cluster-randomized trial in 21 lower resource Pittsburgh neighborhoods with 866 adolescent males ages 13-19. The comparison intervention is a job readiness training program which focuses on the skills needed to prepare youth for entering the workforce, including goal setting, accountability, resume building, and interview preparation. This study will provide urgently needed information about the effectiveness of a gender transformative program, which combines healthy sexuality education, gender norms change, and bystander skills to interrupt peers' disrespectful and harmful behaviors to reduce SV/ARA perpetration among adolescent males. In this manuscript, we outline the rationale for and evaluation design of Manhood 2.0. Clinical Trials #: NCT02427061.

Sexual Assault Supportive Attitudes: Rape Myth Acceptance and Token Resistance in Greek and Non-Greek College Students From Two University Samples in the United States.

Colleges are rape-prone cultures with high rates of sexual victimization. Fraternities' and sororities' relationships with sexual assault are consistent themes in literature focusing on sexual violence among college students. Previous research suggests that fraternity men are more likely to endorse rape-supportive attitudes compared with non-Greek men or sorority women. The present study examines rape-supportive attitudes as well as rape and sexual assault victimization in college students with a focus on gender and Greek-life (i.e., involvement in fraternities or sororities) status variables. College students ( N = 1,002) completed a survey including the Token Resistance to Sex Scale (TRSS), Illinois Rape Myth Acceptance Scale-Short Form (IRMA-S), and items related to past experiences of nonconsensual sex. Two regression models tested predictors of token resistance and rape myth acceptance. Chi-square analyses tested between-group differences of experiencing rape and sexual assault. Gender ( p < .001), Greek status ( p < .001), and race/ethnicity ( p < .001) were predictors for TRSS scores. For IRMA scores, gender ( p < .001), Greek status ( p < .001), and race/ethnicity variables ( p < .001) were also significant. Interaction terms revealed that Greek men had higher token resistance and rape myth acceptance than any other group. Chi-square analyses indicate women more frequently report experiences of rape (χ2 = 25.57, df = 1, p < .001) and sexual assault (χ2 = 31.75, df = 1, p < .001). Men report high rates (40.8%) of experiencing sexual assault "because refusing was useless." No differences of victimization rates were found between Greeks and non-Greeks. Gender and sexual scripting theory can help explain gender differences in attitudes and experiences. Greater endorsement of rape myth acceptance and token resistance by Greeks, who influence college party culture, could be contributing to a culture conducive to rape. Findings demonstrate a continued need for interventions focused on shifting sociocultural dynamics (e.g., traditional roles and sexual scripting) on college campuses.

Improving Health Through Political Activism.

Nurse leaders have a moral and professional obligation to be aware of and influence policy to promote health at local to national levels. As nurse leaders and concerned local residents, the authors engaged in changing the influence of a sexually-oriented business that was impacting the psychosocial health of local citizenry, especially children. Learning city ordinances and state and federal laws was a precursor to change. Professionalism in action can successfully engage community leaders, create change, and support community health.

Is Australia engaged in torturing asylum seekers? A cautionary tale for Europe.

Australian immigration detention has been identified as perpetuating ongoing human rights violations. Concern has been heightened by the assessment of clinicians involved and by the United Nations that this treatment may in fact constitute torture. We discuss the allegations of torture within immigration detention, and the reasons why healthcare providers have an ethical duty to report them. Finally, we will discuss the protective power of ratifying the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment as a means of providing transparency and ethical guidance.

Bioética e atendimento a mulheres vítimas de violência sexual: revisão de literatura / Bioética y atención a las mujeres víctimas de la violencia sexual: revisión de la literatura / Bioethics and support to women victims of sexual violence: literature review

Estudo com o objetivo de refletir, à luz da bioética do risco e proteção, os resultados de revisão de literatura sobre o atendimento a mulheres vítimas de violência sexual. Procedemos busca em periódicos indexados nas bases de dados da Biblioteca Virtual de Saúde e do Scopus, considerando publicações a partir do ano de 2003. A coleta de dados foi realizada em maio de 2013 utilizando os descritores: "violência sexual" ("sexual violence"), "assistência" ("assistance"), "services de saude da mulher" ("women’s health services"), "aborto" ("abortion"), "gravidez" ("pregnancy"). Foram recuperados 15 artigos. Os resultados foram agrupados em categorias temáticas: aspectos bioéticos relacionados ao acesso de mulheres a serviços de atendimento, e, aspectos bioéticos presentes no atendimento. A discussão ocorreu à luz da bioética do risco e proteção, evidenciando que o Estado deve garantir a universalidade do acesso às vítimas de violência sexual, e os profissionais de saúde devem estar preparados bioeticamente para este atendimento.

Estudio con el fin de reflejar, a la luz de la bioética del riesgo y la protección, los resultados de una revisión de la literatura sobre la atención a las mujeres víctimas de violencia sexual. Hemos llevado a cabo la búsqueda en revistas indexadas en las bases de datos de la Biblioteca Virtual en Salud y Scopus, teniendo en cuenta las publicaciones desde el año 2003. La obtención de los datos se realizó en mayo 2013 utilizandose las palabras clave: "violencia sexual" ("sexual violence"), "asistencia ( "assistence"), " servicios de salud para las mujeres" ( "women’s health services"), "aborto" ( "abortion"), "embarazo" ("pregnancy"). Se recuperaron 15 artículos. Los resultados fueron agrupados en categorías temáticas: aspectos bioéticos relacionados con el acceso de las mujeres a los servicios asistenciales y aspectos bioéticos en la asistencia. La discusión se llevó a cabo a la luz de la bioética del riesgo y la protección, evidenciando que el Estado debe garantizar un acceso universal a las víctimas de la violencia y los profesionales de la salud sexual deben tener preparo bioético para este tipo de atención a la salud.

Review article whose purpose is to reflect the light of bioethics risk and protection, the results of a literature review on the care of women victims of sexual violence. Proceeded to search for journals indexed in the database of the Virtual Health Library and Scopus considering publications since 2003. Data collection was conducted in May 2013 using the keywords: "sexual violence", "assistance", "services to women's health", "abortion", "pregnancy". We retrieved 15 publications. The results were grouped into two thematic categories: bioethical issues related to women's access to care services, and bioethical aspects present in attendance. The discussion took place in the light of bioethics risk and protection. The State must ensure universalide access to the victims of sexual violence and health professionals should be prepared for this bioethically care.

Controversies in faith and health care.

Differences in religious faith-based viewpoints (controversies) on the sanctity of human life, acceptable behaviour, health-care technologies and health-care services contribute to the widespread variations in health care worldwide. Faith-linked controversies include family planning, child protection (especially child marriage, female genital mutilation, and immunisation), stigma and harm reduction, violence against women, sexual and reproductive health and HIV, gender, end-of-life issues, and faith activities including prayer. Buddhism, Christianity, Hinduism, Islam, Judaism, and traditional beliefs have similarities and differences in their viewpoints. Improved understanding by health-care providers of the heterogeneity of viewpoints, both within and between faiths, and their effect on health care is important for clinical medicine, public-health programmes, and health-care policy. Increased appreciation in faith leaders of the effect of their teachings on health care is also crucial. This Series paper outlines some faith-related controversies, describes how they influence health-care provision and uptake, and identifies opportunities for research and increased interaction between faith leaders and health-care providers to improve health care.

Sex Offenders Seeking Treatment for Sexual Dysfunction--Ethics, Medicine, and the Law.

INTRODUCTION: The treatment of sexual dysfunction in patients with prior sexual offenses poses ethical and legal dilemmas. Sex offenders are not obligated by law to disclose this history to medical professionals. Over 20% of sex offenders experience sexual dysfunction; however, the number of sex offenders seeking evaluation for sexual dysfunction is unknown. AIMS: The aims of this study were to determine the incidence and characteristics of sex offenders seeking treatment in our clinic; and to review data regarding sex offender recidivism and ethics pertaining to the issue as it relates to treating physicians. METHODS: Sex offenders were identified via three methods: new patient screening in a dedicated sexual medicine clinic, chart review of those on intracavernosal injection (ICI) therapy for erectile dysfunction (ED), and review of patient's status-post placement of penile prosthesis. Charts were cross-referenced with the U.S. Department of Justice National Sex Offender Public Website. Patient characteristics and details of offenses were collected. MAIN OUTCOME MEASURES: The main outcome measures used were a self-reported sexual offense and national registry data. RESULTS: Eighteen male sex offenders were identified: 13 via new patient screening; 3 by review of ICI patients; 1 by review of penile prosthesis data; and 1 prior to penile prosthesis placement. All were primarily referred for ED. Of those with known offenses, 64% were level 3 offenders (most likely to re-offend). The same number had committed crimes against children. All those with complete data had multiple counts of misconduct (average 3.6). Ninety-four percent (17/18) had publicly funded health care. Twelve (67%) were previously treated for sexual dysfunction. CONCLUSIONS: Registered sex offenders are seeking and receiving treatment for sexual dysfunction. It is unknown whether treatment of sexual dysfunction increases the risk of recidivism of sexual offenses. Physicians currently face a difficult choice in deciding whether to treat sexual dysfunction in sex offenders.

Deep brain stimulation to reduce sexual drive.

To date there are few treatment options to reduce high sexual drive or sexual urges in paraphilic patients with a risk for sexual offending. Pharmacological therapy aims to reduce sexual drive by lowering testosterone at the cost of severe side effects. We hypothesize that high sexual drive could also be reduced with deep brain stimulation (DBS) of circuits that generate sexual drive. This approach would help to avoid systemic side effects of antiandrogenic drug therapies. So far the best investigated target to reduce sexual drive is the ventromedial hypothalamus, which was lesioned unilaterally and bilaterally by stereotaxic interventions in paraphilic patients in the 1970s. Here, we discuss DBS as a treatment strategy in patients with severe paraphilic disorders with a serious risk of sexual offending. There are profound ethical and practical issues associated with DBS treatment of paraphilic patients that must be solved before considering such a treatment approach.